Drinking alcohol doesn't increase the risk of HIV treatment failure

No impact on CD4 cell count, but risk of treatment interruptions higher for heavy drinkers

Michael Carter

Published: 30 July 2013

Alcohol
consumption has little impact on key markers used to monitor the health of
individuals with HIV, Swiss research published in the online edition of the Journal of Acquired Immune Deficiency
Syndromes shows. The study involved people starting antiretroviral therapy (ART)
for the first time and individuals who remained treatment naïve. There was no
evidence that drinking alcohol increased the risk of HIV treatment failure or
affected CD4 cell count. However, patients who were heavy drinkers were more
likely to interrupt their antiretroviral therapy compared to non/light drinkers.

“We found no
association between CD4 cell count change over time and the different alcohol
drinking categories, neither in ART initiating nor in ART naïve individuals,”
comment the authors. “However, we found a higher rate of ART interruption in
initiating individuals with severe health risk drinking, but no increased risk
of virological failure.”

There is controversy
about the impact of alcohol consumption on the two key markers used to monitor
the health of patients with HIV – CD4 cell count (am marker of immune
competence) and viral load (level of HIV replication).

Given these
uncertainties Swiss investigators designed a study involving patients who
received care between 2005 and 2012. A total of 2982 individuals starting HIV
therapy were recruited to the study as were 2085 patients who remained
antiretroviral naïve.

Patients were
asked if they drank alcohol and if so the weekly amount they consumed.
Individuals who reported drinking were divided into three categories: light
health risk drinkers, moderate health risk drinkers and severe health risk drinkers.

For patients
starting HIV therapy, the investigators examined the association between
alcohol consumption and virological failure. This was defined as never
suppressing viral load or a sustained rebound in viral load after previous
suppression to undetectable levels. The researchers also explored the
association between drinking and the risk of unauthorised treatment
interruptions lasting seven or more days. The impact of alcohol consumption on
changes in CD4 cell count was examined in both groups of patients.

“Our study uses
one of the largest datasets of self-reported alcohol consumption in HIV-infected
individuals to assess the putative association with immunological and
virological parameters among individuals initiating first ART and ART-naïve
individuals,” comment the investigators.

Overall, 54% of
those starting HIV therapy and 58% of patients who remained treatment naïve
reported the use of alcohol. Only 2% of individuals in each group were
classified as having severe health risk levels of alcohol consumption – weekly
consumption above 40g for women and 60g for men.

The rate of
virological failure among patients starting HIV therapy was 8%. “There was no
significant effect of alcohol consumption on the risk of virological failure,”
write the authors. “As severe health risk drinkers were not shown to have a
higher risk of virological failure, ART should not be withheld.”

Interruption of
HIV treatment without medical approval was noted in 15% of patients. Patients whose
levels of alcohol consumption represented a severe risk to health were twice as
likely to interrupt their therapy than patients who did not drink or who were
light drinkers (HR = 2.24; 95% CI< 1.42-3.52, p < 0.01). This association
was unchanged when non-adherence to therapy was included in the analysis.

There was no evidence
that alcohol consumption affected changes in CD4 cell count in either group of
patients.

“Our data
contribute valuable knowledge to the controversy whether alcohol has an
influence on HIV surrogates or not,” the researchers conclude.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.